1164407102 NPI number — PAUL C NADER MD

Table of content: PAUL C NADER MD (NPI 1164407102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164407102 NPI number — PAUL C NADER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NADER
Provider First Name:
PAUL
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NADER
Provider Other First Name:
PAUL
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164407102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 W 45TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78751-3014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-451-5800
Provider Business Mailing Address Fax Number:
512-459-1399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 DUVAL ROAD
Provider Second Line Business Practice Location Address:
BUILDING 4, SUITE 102
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78759-4277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-832-0999
Provider Business Practice Location Address Fax Number:
512-832-6094
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  F9867 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 124695108 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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